Professional Documents
Culture Documents
KEYWORDS
Climate change Climate justice Social determinants of health
Commercial determinants of health Carbon footprint Allostatic load
KEY POINTS
Climate change is the greatest threat to human health, and it influences the 5 domains of
social determinants of health (SDoH).
It disproportionately affects low-income communities of color who have contributed the
least to greenhouse gas (GHG) emissions and have the lowest carbon footprints.
The health-care sector must lead in connecting carbon emissions to health impacts, advo-
cating for adaptive mitigation and resource allocation in vulnerable communities and de-
carbonization of our own sector.
DEFINITIONS
Climate justice is a concept that addresses the just division, fair sharing, and equitable
distribution of both the benefits and burdens of climate change and responsibilities to
deal with climate change.
Carbon footprint: Total greenhouse gas (GHG) emissions caused by an individual,
event, organization, service, place, or product, expressed as carbon dioxide equiva-
lent (CO2e)
Allostatic load: Cumulative burden of chronic stress and life events.
Planetary health: A solutions-oriented, transdisciplinary field and social movement
focused on analyzing and addressing the impacts of human disruptions to Earth’s nat-
ural systems on human health and all life on Earth.
Commercial determinants of health (CDoH): The private sector activities affecting
public health, either positively or negatively.
Mitigation: Avoiding and reducing GHG emissions through reductions in emissions
and sequestration of existing emissions.
Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA
* Corresponding author. Vanderbilt University School of Nursing, 461 21st Avenue South, Frist
Hall 364, Nashville, TN 37240.
E-mail address: Carol.c.ziegler@vanderbilt.edu
Twitter: @DrCarolZiegler (C.Z.); @JamesMuturi5 (J.M.)
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646 Ziegler & Muchira
INTRODUCTION
The World Health Organization has named climate change the greatest threat to
human health.1–3 Globally, ecological impacts from GHG emissions most severely
impact the health of communities that have contributed the least to the problem,
making climate change an urgent justice issue. Climate justice directly connects to
all social determinants of health (SDoH) and social determinants of equity.4 People
with the lowest carbon footprints are most likely to suffer the most severe conse-
quences to their physical and mental well-being, economic insecurity, and com-
munity instability due to climate change globally, including in the United
States.5–7 The disproportionate burdens accruing in communities who benefit
the least from the profits associated with GHG-emitting activities of industries illu-
minates the exploitive and complex relationships between SDoH and commercial
determinants of health (CDoH). The marked increase in fossil fuel consumption
accompanying the industrial revolution created wealth in industrialized nations
and for-profit companies and marked the beginning of the shift in atmospheric
GHG emissions that have resulted in the current climate crisis.8 Efforts to reduce
GHG emissions for planetary and human health priorities often conflict with the
financial and political interests of powerful entities.9 The health-care industry
must lead by example and meaningfully advocate for adaptive mitigation through
practice, education, research, and policy advocacy that centers health and
climate justice for those disproportionately affected.
Background
Increased accumulation of atmospheric GHG resulting from the burning of fossil fuels
for energy causes increases in extreme weather, temperature, and sea level rise.10 The
resulting ecological impacts on our planet directly and significantly influence human
and population health and well-being.2 The goal of the health-care sector, especially
primary care, is to provide people with the opportunity to achieve optimal health for as
long as possible—to live as well as they can, as long as they can—compressing
morbidity to the shortest time possible at the end of life.11,12 Optimal time on Earth
in a healthy state provides increased opportunities for meaningful actions that affect
families and communities for generations-like achieving personal fulfillment, accruing
intergenerational wealth, investing in rewarding social relationships and building com-
munities. Optimizing health not only “buys time” but also decreases costs (including
opportunity costs) to individuals, communities, the health-care system and the nation
as a whole.13
Ethical concerns connect climate justice and health equity—the equal access to
the opportunity to achieve optimal health and its innumerable connected intergen-
erational benefits. To ensure equitable access to optimal health span in the face of
climate change, we must focus on climate justice, integrating adaptation-directed
programs while simultaneously mitigating the effects of carbon emissions. The
health-care sector is a significant contributor to GHG emissions and must priori-
tize reaching net zero emissions as soon as possible.14 This article will explore
how climate change contributes to health disparities in vulnerable populations,
why this is a justice issue for primary care to address, and what we can do to pro-
mote equity, resilience, and adaption in our current economic system while miti-
gating GHG emissions.
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Climate Change 647
Health Impacts: How These Ecological Impacts Affect Mental and Physical Health
Climate change is projected to impact physical and mental health causing approxi-
mately 250, 000 additional deaths between 2030 and 2050, and costing US$2 to
US$4 billion per year in direct health-care costs by 2030.30 Deaths from extreme cli-
matic conditions such as extreme heat waves are now evident—both in high-
income and low to middle-income countries—most of the deaths resulting from car-
diovascular, kidney and respiratory diseases, and mental illness.31
In regards to mental health, the American Psychiatric Association recognizes that
climate change poses a significant threat to mental health with a disproportionate
burden imposed on children, elderly, and the chronically ill, those with mental illnesses
and mobility impairments, and women especially pregnant and postpartum
women.32–35 These mental disorders include posttraumatic stress disorder, depres-
sion, anxiety, phobias, sleep disorders, attachment disorders, and substance abuse.
In addition to the effects on individual mental health, the possibility of extreme weather
and climate disasters creating droughts, flooding, severe storm, tropical cyclone,
wildfires, and winter storm may lead to increased conflict and civil strife,36,37 which
significantly challenge mental health of vast populations of people simultaneously.
In the best of times, effective mental health resources are very limited, exacerbating
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648 Ziegler & Muchira
existing mental health issues and prolonging time to effective identification and
treatment.
In terms of physical health, it is important to note that the root cause of climate
change—the burning of fossil fuels—is a major contributor to worldwide mortality
through airborne particulate matter and ozone, and ambient air pollution, and is the
leading cause of global disease burden in low and middle income countries (LMICs).38
Fine particulate matter (PM2.5) emissions from fossil fuels were estimated to cause
10.2 million global excess deaths in 2012 alone via its cardiac and pulmonary disease
impacts.39 Increasing sea levels, too, can affect physical health, with our current un-
precedented increase in temperature,29 increasing injuries, drowning, and water and
soil salinization issues.40
The increases in extreme heat, which are now common in the United States and
around the globe, can have devastating physical effects—especially in low-resource
countries where adequate cooling measures are often unavailable.41,42 Heat stroke
is a condition requiring immediate medical attention that occurs from exposure to
extreme heat. It occurs when the body temperature increases above 40 C, which if un-
treated is fatal in 10% to 50% of cases resulting from brain, heart, and kidneys dam-
age.41 Heat stress or heat exhaustion, although less immediate, can cause severe
dehydration, acute cerebrovascular accidents, and may contribute to formation of
blood clots and other minor manifestations such as lethargy, irritability, headache.41
In addition, extreme heat compounds the health effects of outdoor air quality by
increasing the particulate levels/air pollutants, creating a more serious synergy of air
contamination and heat stress, and leading to more serious health harms that those
from either alone. People working outdoors are particularly at high risk of heat stress
due to increases in core body temperature from muscle activity and the combined ef-
fects of heat and humidity.41
The world continues to experience several intense climate-related variable weather
patterns such as intense heat waves, flooding, droughts, increase in forest fires, tor-
nadoes, and hurricanes. Extreme temperatures are expected to lead to more heat-
related illnesses and worsen some chronic medical conditions such as heart disease,
respiratory disease, and diabetes.43,44 At the same time, some medications (such as
some antidepressants, diuretics, and beta-blockers) taken for a chronic illness may in-
crease an individual’s sensitivity to heat and consequently, people with obesity and
heart disease will have at greater risk of heat illnesses or mortality.44 The climate-
related weather changes described above pose humanitarian crises and may lead
to civil conflict and forced migration resulting in health-related consequences, psy-
chological distress, risks during pregnancy and childbirth, exposure to violence and
discrimination, as well as a lack of adequate health-care services and social sup-
port.45,46 Lessons learnt from global terrorism and recent pandemics should gear us
to prepare for potential risks developing from climate change. Despite the over-
whelming evidence and lessons learnt from other threats, there is still underinvestment
and unpreparedness in public health measures and health systems preparation to
address climate change and subsequent large-scale health impacts.
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Climate Change 649
Promoting Cobenefits
Providers can also advocate for cobenefits in the clinical setting. Cobenefits align car-
bon mitigation with health-promoting activities, and integrating these priorities into ed-
ucation, practice, research, and policy aligns the agendas of planetary and human
health. Project Drawdown cites the top 100 ways to mitigate GHG53 and Nurses
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650 Ziegler & Muchira
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Climate Change 651
SUMMARY
Climate change is the greatest threat to human health today. The root cause of climate
change, fossil fuel emissions, also contributes significantly to the top 100 causes of
death globally. Therefore, transitioning to clean energy improves health and promotes
climate justice.
Low-income families contribute the least to carbon emissions yet bear the greatest health
and financial burdens associated with climate change.
Heat exposure, respiratory conditions from poor air quality, vector and allergen-borne
illnesses, injuries from extreme weather events, and mental health impacts are climate-
related health issues that primary care providers must be aware of and prepared to manage.
Climate education and planetary health must be integrated in education across all health-
related fields and required for continued licensure certification.
Health-care sector emissions are a significant contributor to climate change and achieving
net zero emissions as a sector must be prioritized.
DISCLOSURE
SUPPLEMENTARY DATA
REFERENCES
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652 Ziegler & Muchira
8. Martinez LH. Post industrial revolution human activity and climate change: Why
The United States must implement mandatory limits on industrial greenhouse
gas emmissions. J Land Use Environ Law 2005;403–21.
9. Hansen T. Stranded assets and reduced profits: Analyzing the economic under-
pinnings of the fossil fuel industry’s resistance to climate stabilization. Renew
Sustain Energy Rev 2022;158:112144.
10. Yoro KO, Daramola MO. CO2 emission sources, greenhouse gases, and the
global warming effect. In: Advances in carbon Capture. Elsevier; 2020. p. 3–28.
11. Crimmins EM. Lifespan and healthspan: past, present, and promise. Gerontol
2015;55(6):901–11.
12. Partridge L, Deelen J, Slagboom PE. Facing up to the global challenges of
ageing. Nature 2018;561(7721):45–56.
13. Semenza JC. Climate change and human health. Int J Environ Res Public Health
2014;11(7):7347–53.
14. Eckelman MJ, Sherman J. Environmental impacts of the US health care system
and effects on public health. PLoS One 2016;11(6):e0157014.
15. Goldstein B, Gounaridis D, Newell JP. The carbon footprint of household energy
use in the United States. Proc Natl Acad Sci 2020;117(32):19122–30.
16. Bruckner B, Hubacek K, Shan Y, et al. Impacts of poverty alleviation on national
and global carbon emissions. Nat Sustain 2022;5(4):311–20.
17. Kennedy EH, Krahn H, Krogman NT. Egregious emitters: Disproportionality in
household carbon footprints. Environ Behav 2014;46(5):535–55.
18. Gasper R, Blohm A, Ruth M. Social and economic impacts of climate change on
the urban environment. Curr Opin Environ Sustain 2011;3(3):150–7.
19. Puaschunder JM. Climate in the 21st century: a macroeconomic model of fair
global warming benefits distribution to grant climate justice around the world
and over time. In: ; 2018.
20. Diffenbaugh NS, Burke M. Global warming has increased global economic
inequality. Proc Natl Acad Sci 2019;116(20):9808–13.
21. Robinette JW, Charles ST, Almeida DM, et al. Neighborhood features and phys-
iological risk: An examination of allostatic load. Health Place 2016;41:110–8.
22. Blair C, Raver CC, Granger D, et al. Family Life Project Key Investigators. Allosta-
sis and allostatic load in the context of poverty in early childhood. Dev Psychopa-
thol 2011;23(3):845–57.
23. Schulz AJ, Mentz G, Lachance L, et al. Associations between socioeconomic sta-
tus and allostatic load: effects of neighborhood poverty and tests of mediating
pathways. Am J Public Health 2012;102(9):1706–14.
24. Dwyer-Lindgren L, Kendrick P, Kelly YO, et al. Life expectancy by county, race,
and ethnicity in the USA, 2000–19: a systematic analysis of health disparities.
Lancet 2022;400(10345):25–38.
25. Haines A, Kovats RS, Campbell-Lendrum D, et al. Climate change and human
health: impacts, vulnerability and public health. Publ Health 2006;120(7):585–96.
26. McMichael AJ, Haines J, Slooff R, et al, World Health Organization. Climate
change and human health: an assessment/prepared by a Task Group on behalf
of the World Health Organization, the World Meteorological Association and the
United Nations Environment Programme; editors: AJ McMichael. et al. In: Climate
Change and Human Health: An Assessment/Prepared by a Task Group on Behalf
of the World Health Organization, the World Meteorological Association and the
United Nations Environment Programme; Editors:. ; 1996.
27. Applebaum KM, Graham J, Gray GM, et al. An overview of occupational risks
from climate change. Curr Environ Health Rep 2016;3:13–22.
Downloaded for Carlos Hernan Castaneda Ruiz (cas.memi1966@gmail.com) at University of KwaZulu-Natal from ClinicalKey.com by
Elsevier on October 21, 2023. For personal use only. No other uses without permission. Copyright ©2023. Elsevier Inc. All rights reserved.
Climate Change 653
28. Schulte PA, Chun H. Climate change and occupational safety and health: estab-
lishing a preliminary framework. J Occup Environ Hyg 2009;6(9):542–54.
29. Meierrieks D. Weather shocks, climate change and human health. World Dev
2021;138:105228.
30. World Health Organization. Climate change and health. Published October 30,
2022. Accessed January 24, 2023. https://www.who.int/news-room/fact-sheets/
detail/climate-change-and-health.
31. Centers for Disease Control and Prevention. Climate Effects on Health. Published April
25, 2022. Accessed January 24, 2023. https://www.cdc.gov/climateandhealth/
effects/default.htm.
32. Ursano RJ, Morganstein JC, Cooper R. APA Resource Document: Resource Docu-
ment on Mental Health and Climate Change. Published online 2017. Accessed
January 24, 2022. https://www.psychiatry.org/File%20Library/Psychiatrists/
Directories/Library-and-Archive/resource_documents/2017-Resource-Document-
Mental-Health-Climate-Change.pdf.
33. Xiong X, Harville EW, Mattison DR, et al. Hurricane Katrina experience and the
risk of post-traumatic stress disorder and depression among pregnant women.
Am J Disaster Med 2010;5(3):181–7. https://doi.org/10.5055/ajdm.2010.0020.
34. Bei B, Bryant C, Gilson KM, et al. A prospective study of the impact of floods on
the mental and physical health of older adults. Aging Ment Health 2013;17(8):
992–1002. https://doi.org/10.1080/13607863.2013.799119.
35. Burke SEL, Sanson AV, Van Hoorn J. The Psychological Effects of Climate
Change on Children. Curr Psychiatry Rep 2018;20(5):35. https://doi.org/10.
1007/s11920-018-0896-9.
36. Ministry of Health. National strategic plan for prevention and control of NCDs
2020/21-2025/26. 2021. Available at: https://www.health.go.ke/wp-content/
uploads/2021/07/Kenya-Non-Communicable-Disease-NCD-Strategic-Plan-2021-
2025.pdf. Accessed December 12, 2022.
37. Balsari S, Dresser C, Leaning J. Climate Change, Migration, and Civil Strife. Curr
Environ Health Rep 2020;7(4):404–14.
38. Forouzanfar Mohammad H, Afshin Ashkan, Alexander Lily T, et al. Global,
regional, and national comparative risk assessment of 79 behavioural, environ-
mental and occupational, and metabolic risks or clusters of risks, 1990–2015: a
systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016;
388(10053):1659–724.
39. Vohra K, Vodonos A, Schwartz J, et al. Global mortality from outdoor fine particle
pollution generated by fossil fuel combustion: Results from GEOS-Chem. Environ
Res 2021;195:110754.
40. Mazhar S, Pellegrini E, Contin M, et al. Impacts of salinization caused by sea level
rise on the biological processes of coastal soils - A review. Front Environ Sci.
2022;10. Accessed March 3, 2023. https://www.frontiersin.org/articles/10.3389/
fenvs.2022.909415.
41. Howard S, Krishna G. How hot weather kills: the rising public health dangers of
extreme heat. BMJ 2022;378:o1741.
42. Parkes B, Buzan JR, Huber M. Heat stress in Africa under high intensity climate
change. Int J Biometeorol 2022;66(8):1531–45. https://doi.org/10.1007/s00484-
022-02295-1.
43. Sarofim MC, Saha S, Hawkins MD, et al. Ch. 2: temperature-related death and
illness. The impacts of climate change on human health in the United States: a
Scientific Assessment. U.S. Global Change Research Program; 2016. p. 43–68.
Downloaded for Carlos Hernan Castaneda Ruiz (cas.memi1966@gmail.com) at University of KwaZulu-Natal from ClinicalKey.com by
Elsevier on October 21, 2023. For personal use only. No other uses without permission. Copyright ©2023. Elsevier Inc. All rights reserved.
654 Ziegler & Muchira
Downloaded for Carlos Hernan Castaneda Ruiz (cas.memi1966@gmail.com) at University of KwaZulu-Natal from ClinicalKey.com by
Elsevier on October 21, 2023. For personal use only. No other uses without permission. Copyright ©2023. Elsevier Inc. All rights reserved.
Climate Change 655
61. Guo Z, Zhang Z, Wu X, et al. Building shading affects the ecosystem service of
urban green spaces: Carbon capture in street canyons. Ecol Model 2020;431:
109178.
62. Shadman S, Khalid PA, Hanafiah MM, et al. The carbon sequestration potential of
urban public parks of densely populated cities to improve environmental sustain-
ability. Sustain Energy Technol Assess 2022;52:102064.
63. Nowak DJ, McPherson EG. Quantifying the impact of trees: The Chicago urban
forest climate project. Unasylva 1993;173(44):39–44.
64. Lai Y, Kontokosta CE. The impact of urban street tree species on air quality and
respiratory illness: A spatial analysis of large-scale, high-resolution urban data.
Health Place 2019;56:80–7.
65. Beckett KP, Freer Smith P, Taylor G. Effective tree species for local air quality
management. Arboric J 2000;26(1):12–9.
66. Mariam N, Valerie K, Karin D, et al. Limiting food waste via grassroots initiatives
as a potential for climate change mitigation: a systematic review. Environ Res Lett
2020;15(12):123008.
67. Chapagain A, James K. Accounting for the impact of food waste on water re-
sources and climate change. Food Ind Wastes 2013;217–36.
68. Tonn B, Hawkins B, Rose E, et al. Income, housing and health: Poverty in the
United States through the prism of residential energy efficiency programs. En-
ergy Res Soc Sci 2021;73:101945.
69. Kurth A, Potter T. The Public Health Crisis Is Planetary—and Nursing Is Crucial to
Addressing It. Am J Public Health 2022;112(S3):S259–61.
70. Redvers N. The value of global indigenous knowledge in planetary health. Chal-
lenges 2018;9(2):30.
71. Redvers N. The determinants of planetary health. Lancet Planet Health 2021;5(3):
e111–2.
72. Redvers N, Poelina A, Schultz C, et al. Indigenous natural and first law in plane-
tary health. Challenges 2020;11(2):29.
73. Redvers N, Celidwen Y, Schultz C, et al. The determinants of planetary health: an
Indigenous consensus perspective. Lancet Planet Health 2022;6(2):e156–63.
74. Howard C, Beagley J, Eissa M, et al. Why we need a fossil fuel non-proliferation
treaty. Lancet Planet Health 2022;6(10):e777–8.
75. Purohit A, Smith J, Hibble A. Does telemedicine reduce the carbon footprint of
healthcare? A systematic review. Future Healthc J 2021;8(1):e85.
76. Zotova O, Pétrin-Desrosiers C, Gopfert A, et al. Carbon-neutral medical confer-
ences should be the norm. Lancet Planet Health 2020;4(2):e48–50.
77. Roberts I, Godlee F. Reducing the carbon footprint of medical conferences. BMJ
2007;334(7589):324–5.
Downloaded for Carlos Hernan Castaneda Ruiz (cas.memi1966@gmail.com) at University of KwaZulu-Natal from ClinicalKey.com by
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